Skip to main content
SpringerLink
Log in

Heart failure and atrial fibrillation in patients with an interatrial shunt

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Objective

Congenital interatrial shunt can unload the left atrium (LA) and may lower the risk of new-onset heart failure (HF) or atrial fibrillation (AF). We evaluated the risk of new-onset HF or AF in patients with and without interatrial shunt.

Methods

We enrolled 2660 consecutive patients with acute stroke or transient ischemic attack (TIA) who underwent transesophageal echocardiography at Seoul National University Bundang Hospital from January 1, 2006 to December 31, 2018. The primary outcomes were 10-year new-onset HF, new-onset AF, and new-onset HF or AF composite.

Results

Overall, 466 (17.5%) patients with an interatrial shunt had smaller E velocity (0.66 ± 0.21 vs. 0.69 ± 0.22 m/s, P = 0.037) and smaller E/e′ (9.1 ± 4.0 vs. 10.0 ± 5.0, P = 0.001) than 2194 (82.5%) patients without an interatrial shunt. The 10-year incidence of AF, HF, and AF or HF composite was lower in patients with an interatrial shunt (10-year AF, 11.2 vs. 17.8%, P < 0.001; 10-year HF, 6.2 vs. 10.4%, P = 0.005; 10-year AF or HF composite, 16.5 vs. 23.4%, P = 0.001). In multivariable analysis, the presence of an interatrial shunt was associated with a 38% (HR 0.62, 95% CI 0.40–0.96), 40% (HR 0.60; 95% CI 0.39–0.93), and 26% (HR 0.74; 95% CI 0.57–0.96) reduced risk for new-onset HF, AF, and new-onset HF or AF composite, respectively.

Conclusion

In patients with interatrial shunt, the risk of AF and HF was lower. Interatrial shunt may be beneficial, and the closure of an interatrial shunt should be performed only in carefully selected patients.

Graphic abstract

An interatrial shunt can unload the left atrium. In patients with stroke or TIA, the presence of an interatrial shunt was associated with a reduced risk for new-onset HF and AF. AF atrial fibrillation, HF heart failure, HR hazard ratio, LA left atrium

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Fisher DC, Fisher EA, Budd JH, Rosen SE, Goldman ME (1995) The incidence of patent foramen ovale in 1000 consecutive patients: a contrast transesophageal echocardiography study. Chest 107(6):1504–1509

    Article  CAS  Google Scholar 

  2. Lechat P, Mas JL, Lascault G et al (1988) Prevalence of patent foramen ovale in patients with stroke. N Engl J Med 318(18):1148–1152

    Article  CAS  Google Scholar 

  3. Mas JL, Arquizan C, Lamy C et al (2001) Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med 345(24):1740–1746

    Article  CAS  Google Scholar 

  4. Mas JL, Derumeaux G, Guillon B et al (2017) Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med. 377(11):1011–1021

    Article  CAS  Google Scholar 

  5. Sondergaard L, Kasner SE, Rhodes JF et al (2017) Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med 377(11):1033–1042

    Article  Google Scholar 

  6. Park JJ, Park JH, Hwang IC, Park JB, Cho GY, Marwick TH (2020) Left atrial strain as a predictor of new-onset atrial fibrillation in patients. JACC Cardiovasc Imaging 13:2071–2081

    Article  Google Scholar 

  7. Hasenfuss G, Hayward C, Burkhoff D et al (2016) A transcatheter intracardiac shunt device for heart failure with preserved ejection fraction (REDUCE LAP-HF): a multicentre, open-label, single-arm, phase 1 trial. Lancet 387(10025):1298–1304

    Article  Google Scholar 

  8. Feldman T, Mauri L, Kahwash R et al (2018) Transcatheter interatrial shunt device for the treatment of heart failure with preserved ejection fraction (REDUCE LAP-HF I [reduce elevated left atrial pressure in patients with heart failure]): a phase 2, randomized sham-controlled trial. Circulation 137(4):364–375

    Article  Google Scholar 

  9. Kaye D, Shah SJ, Borlaug BA et al (2014) Effects of an interatrial shunt on rest and exercise hemodynamics: results of a computer simulation in heart failure. J Card Fail 20(3):212–221

    Article  Google Scholar 

  10. Kim BJ, Han MK, Park TH et al (2014) Current status of acute stroke management in Korea: a report on a multicenter, comprehensive acute stroke registry. Int J Stroke 9(4):514–518

    Article  Google Scholar 

  11. Lang RM, Badano LP, Mor-Avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 28(1):1-39.e14

    Article  Google Scholar 

  12. Hahn RT, Abraham T, Adams MS et al (2013) Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American society of echocardiography and the society of cardiovascular anesthesiologists. J Am Soc Echocardiogr 26(9):921–964

    Article  Google Scholar 

  13. Hagen PT, Scholz DG, Edwards WD (1984) Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 59(1):17–20

    Article  CAS  Google Scholar 

  14. Hunter RJ, Liu Y, Lu Y, Wang W, Schilling RJ (2012) Left atrial wall stress distribution and its relationship to electrophysiologic remodeling in persistent atrial fibrillation. Circ Arrhythm Electrophysiol 5(2):351–360

    Article  Google Scholar 

  15. Potpara TS, Polovina MM, Licina MM, Marinkovic JM, Lip GY (2013) Predictors and prognostic implications of incident heart failure following the first diagnosis of atrial fibrillation in patients with structurally normal hearts: the Belgrade atrial fibrillation study. Eur J Heart Fail 15(4):415–424

    Article  Google Scholar 

  16. Benetti E, Fania C, Palatini P (2015) Validation of the A&D BP UA-651 device with a wide-range cuff for home blood pressure measurement according to the European society of hypertension international protocol revision 2010. Blood Press Monit 20(3):164–167

    Article  Google Scholar 

  17. Lee SE, Lee HY, Cho HJ et al (2017) Clinical characteristics and outcome of acute heart failure in Korea: results from the Korean acute heart failure registry (KorAHF). Korean Circ J 47(3):341–353

    Article  Google Scholar 

  18. Wu CC, Chen WJ, Chen MF, Liau CS, Chu SH, Lee YT (1993) Left-to-right shunt through patent foramen ovale in adult patients with left-sided cardiac lesions: a transesophageal echocardiographic study. Am Heart J 125(5 Pt 1):1369–1374

    Article  CAS  Google Scholar 

  19. Rossi A, Temporelli PL, Quintana M et al (2009) Independent relationship of left atrial size and mortality in patients with heart failure: an individual patient meta-analysis of longitudinal data (MeRGE heart failure). Eur J Heart Fail 11(10):929–936

    Article  Google Scholar 

  20. Paitazoglou C, Ozdemir R, Pfister R et al (2019) The AFR-PRELIEVE trial: a prospective, non-randomised, pilot study to assess the atrial flow regulator (AFR) in heart failure patients with either preserved or reduced ejection fraction. EuroIntervention 15(5):403–410

    Article  Google Scholar 

  21. Del Trigo M, Bergeron S, Bernier M et al (2016) Unidirectional left-to-right interatrial shunting for treatment of patients with heart failure with reduced ejection fraction: a safety and proof-of-principle cohort study. Lancet 387(10025):1290–1297

    Article  Google Scholar 

  22. Rodes-Cabau J, Bernier M, Amat-Santos IJ et al (2018) Interatrial shunting for heart failure: early and late results from the first-in-human experience with the V wave system. JACC Cardiovasc Interv 11(22):2300–2310

    Article  Google Scholar 

  23. Sanna T, Diener HC, Passman RS et al (2014) Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med 370(26):2478–2486

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This work was supported by Grant no. 13-2020-014 from the Seoul National University Bundang Hospital (SNUBH) Research Fund.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173, Bundang-Gu, Seongnam-Si, 13620, Gyeonggi-do, Republic of Korea

    Jin Joo Park, Goo-Yeong Cho, Wonsuk Choi, In-Chang Hwang, Yeonyee Yoon & Chang-Hwan Yoon

  2. Department of Neurology, Cerebrovascular Disease Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173, Bundang-Gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea

    Jun Yup Kim, Beom-Joon Kim, Moon-Ku Han & Hee-Joon Bae

Authors
  1. Jin Joo Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Goo-Yeong Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wonsuk Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. In-Chang Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jun Yup Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yeonyee Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chang-Hwan Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Beom-Joon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Moon-Ku Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hee-Joon Bae
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Goo-Yeong Cho or Hee-Joon Bae.

Ethics declarations

Conflict of interest

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file 1 (DOCX 25 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Park, J.J., Cho, GY., Choi, W. et al. Heart failure and atrial fibrillation in patients with an interatrial shunt. Clin Res Cardiol 110, 1270–1279 (2021). https://doi.org/10.1007/s00392-021-01811-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-021-01811-4

Keywords

Search

Navigation